Previous Page | Print this page
Links on this page
- What are tonsils?
- When are tonsils removed?
- Adenoids
- X rays of the adenoids
- Adult tonsillectomy
- The post operative period
The tonsils have a specific job of producing antibodies which fight germs like bacteria and viruses. They’re part of the immune system in antibody production until around the age of 5 by which time their antibody producing function has literally gone. Antibodies form in the tonsils and as you swallow one of the ways they enter your immune system is by being squirted into the saliva through little canals leading from the inside of the tonsil to its surface.
These canals unfortunately can be the cause of recurrent tonsillitis in that as antibody producing function decreases, debris collects in the canals themselves causing tonsillitis.
The symptoms of tonsillitis are attacks of sore throat, often poor appetite and often in older cases chronic stomach pains can be one of the symptoms. This because in development terms the stomach starts in the area of the mouth and then descends into the abdomen but takes with it a nerve supply. The stomach pain is thus what we call a “referred symptom”. Like in a heart attack where the pain is classically referred down the left arm….
There was a time when a tonsillectomy was done without adequate reason. The tendency then sprang to the opposite extreme and literally no tonsillectomies were done. This was the wrong decision and we now have a far better balance between medical and surgical indications for the tonsillectomy operation. I’m particularly sensitive as to how the mother feels about the whole situation and regard her opinion as being extremely important.
Indications for tonsillectomy are generally attacks of tonsillitis some 3 times a year needing antibiotic treatment. Most fall into this category. As regards antibiotic it’s well known taking excess antibiotic is not a good idea in that it can destroy the many useful bacteria in the body and lead to development of bacteria very resistant to antibiotics. This can be a big problem.
When tonsils are so large they actually obstruct breathing and also produce changes in speech pattern (the so called “hot potato” speech) surgery is needed. The symptoms will be not only difficulty in breathing but also often very significant snoring with disturbance of sleep and apnoeic episodes.
There are cases where you find tonsils almost touching each other in the middle. So significant obstruction by huge tonsils and adenoids are a definite indication for surgery with dramatically good results. Also recall the large adenoids can also be responsible for recurrent middle ear infections by blocking the eustachian tube which drains the ear.
- If one tonsil is much larger than the other removal is often indicated for the need to have microscopic examination of tonsil tissue to exclude certain dangerous illnesses. This is an unusual indication but is something one needs bear in mind and which needs assessment by an ENT Specialist.
- Tonsil abscesses : quinsy. This is a relatively rare condition presenting with extremely severe pain.It’s one sided. The patient usually has enormous difficulty trying to swallow because of pain and often comes in almost unable to open the mouth because of the marked tenderness. Quinsy’s in adults can often be drained under local anaesthetic in the rooms but if there’s any recurrence tonsillectomy is indicated.
Adenoids are no more than tonsils lying behind the nose.The tissue is exactly the same.They often tend to mirror the tonsil size so if the tonsils are large it’s likely the adenoids will be of similar size. Large adenoids can cause not only obstruction to breathing but are a major cause of snoring in young children. Also predisposing to middle ear infections.
Please remember adenoid X Rays are notoriously misleading regarding the actual adenoid size and the symptoms produced. ENTSurgeons will often disagree with the Radiologists comment on their size. With all respect to Radiologists they usually significantly underestimate the obstructive element. The adenoids can extend into the back of the nose and this is not something shown on X Rays. So recall X Rays of adenoids are very controversial in assessing adenoid size. Beware of regarding them as the definitive opinion.
Yes adults can get chronic tonsillitis. Unfortunately if you go on getting intermittent bouts of tonsillitis after the age of 5 or 6 the chances of outgrowing it become much reduced.In young children we can often watch before deciding. In adults however it really is a chronic relapsing situation with a fairly painful “end play”. I say that because an adult tonsillectomy is in general a fairly painful procedure with however something to delight in all women.
Namely that you lose between 3 and 4 kgs weight because of post op “discomfort”. However there’s no guarantee you won’t put it on again. So, unless you’re lucky, adult tonsillectomy can be quite a challenging week or 10 days regards pain and discomfort.
Adult tonsillitis often doesn’t respond quickly to antibiotic and can be difficult to settle on medication.
The indications of adult tonsillectomy are far fewer attacks than required for a child’s tonsillectomy. The history will be one of relapsing sore throat maybe once or twice a year, occasional more frequently. It’s an ongoing situation with the adult finally deciding they’ve had enough and are prepared to have the operation. Adenoids can be present in adults and as such we always check for adenoidal enlargement even in the adult patient.
So once a tonsillectomy has been decided on what is the general procedure?
- Firstly as regards hospital stay. There’s a very healthy swing to “day surgery” where one tries to ensure that all tonsillectomy cases go home the same day. This is literally routine in the case of children and as regards adults one comes around in the evening and the option is completely theirs as to whether they wish to stay or go home. There’s no medical need to stay in hospital.They’re noisy and your own bed and home are much more comfortable.
- I work at the Claremont Hospital with whom I’ve had a long and pleasant association. The theatre staff has been there many years and are superb as are the recovery ladies who are absolutely exceptional.
- You will be asked not to have a full meal after the preceding supper, but certainly can have something like clear apple juice at 6 a.m. the day of the operation. There was a time when children particularly were starved from the night before but this has proven completely wrong. If one does this the child is short of not only fluid but also glucose and this is definitely not a good idea. So you’re welcome to give your child a mouthful or two of clear apple juice at 6 a.m. This is fully subscribed to by the anaesthetists and is in fact their suggestion. The same applies to adults. But nothing solid may be taken.
- Admission is at 7 a.m. and surgery done during the morning. The time taken for tonsillectomy varies, but is on average between 30 – 45 minutes.
- You’ll be seen by the anaesthetist who will ask you questions. You must give any information you feel appropriate.
- The Claremont theatre is particularly “user friendly”. Parents or partners are strongly encouraged to come into theatre while the anaesthetic induction is taking place. It’s extremely reassuring to have friends and family with you when you’re in an operating theatre…to say the least.
There are seldom any dangerous problems following a tonsillectomy but of course you’ll be concerned about possible bleeding. If this rare complication occurs please phone me immediately. Some oozing on the day of the operation is well within the range of normal. But if you have concerns please contact me. In the rare occurrence that I might not be contactable phone the Claremont Hospital Emergency Unit. Help is always available. Don’t hesitate to use the service.
We have a tonsillectomy pamphlet giving a general overview of what is likely to happen. But recall everyone is an individual. Ear ache is a common complaint and referred from the tonsil bed.There will be difficulty in swallowing and as regards food one suggests a sloppy diet is often useful. But quite frankly the patient can eat whatever they want…with the exception of bananas which cause incredible pain.
There must be an enzyme responsible. Ignore all the advice you’re going to get from “well wishers” about what you mustn’t eat and must do. Each case is individual. And if your child wishes to go to school after a couple of days, let them go for a few of hours and see how they fit in. They seldom last a full day though there are exceptions.
So the need to keep your child at home for a week is inappropriate unless you wish to do so. They decide what they can do. As regards the antibiotic and painkiller, give them as directed. One recommends you give the painkiller on a regular basis to help avoid a severe pain situation. One stresses that particularly in the young the intake of fluid is essential to avoid dehydration. Encourage fluids.